BackgroundIntracranial stents and flow diverters contain significant amounts of metals, notably nickel, which can cause allergic reactions in a considerable portion of the population. These allergic responses may lead to complications like in-stent stenosis (ISS) and TIA/Stroke in patients receiving stents or flow diverters for intracranial aneurysms.MethodsWe conducted a systematic review of studies from inception until July 2023, which reported outcomes of patients with metal allergy undergoing neurovascular stenting. The skin patch test was used to group patients into those with positive, negative, or absent patch test results but with a known history of metal allergy.ResultsOur review included seven studies with a total of 39 patients. Among them, 87% had a history of metal allergy before treatment. Most aneurysms (89%) were in the anterior circulation and the rest (11%) were in the posterior circulation. Skin patch tests were performed in 59% of patients, with 24% showing positive results and 33% negative. Incidental ISS was observed in 18% of patients, and the rate of TIA/Stroke was reported in 21%. The pooled rates of ISS and TIA/Stroke were higher in the first group (43% and 38%) compared to the second (18% and 9%) and third groups (15% and 15%), but these differences were not statistically significant.ConclusionsThe current neurosurgical literature does not provide a conclusive association between metal allergy and increased complications among patients undergoing neurovascular stenting. Further studies are necessary to gain a more comprehensive understanding of this topic.

中文翻译：

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金属过敏和神经血管支架置入术：系统评价

背景颅内支架和分流器含有大量金属，尤其是镍，可能会在相当一部分人群中引起过敏反应。对于接受颅内动脉瘤支架或分流器的患者来说，这些过敏反应可能会导致支架内狭窄 (ISS) 和 TIA/中风等并发症。方法我们对从开始到 2023 年 7 月的研究进行了系统回顾，其中报告了金属支架患者的结果接受神经血管支架置入术的过敏。皮肤斑贴试验用于将患者分为斑贴试验结果呈阳性、阴性或无斑贴试验结果但已知有金属过敏史的患者。结果我们的回顾包括 7 项研究，总共 39 名患者。其中，87%的人在治疗前有金属过敏史。大多数动脉瘤（89%）位于前循环，其余（11%）位于后循环。59% 的患者进行了皮肤斑贴试验，其中 24% 显示阳性结果，33% 显示阴性结果。18% 的患者观察到意外 ISS，21% 的患者发生 TIA/中风。第一组的 ISS 和 TIA/中风合并发生率（43% 和 38%）高于第二组（18% 和 9%）和第三组（15% 和 15%），但这些差异没有统计学意义结论目前的神经外科文献并未提供金属过敏与接受神经血管支架置入术的患者并发症增加之间确实的关联。为了更全面地了解这个主题，需要进一步的研究。